To fight HIV in D.C., bring PEPFAR home

By
washingtonpost.com editors

By Shannon L. Hader
Washington

Much attention is paid to HIV rates in the District, and rightly so. We are on the front line of a tragic pandemic, with 3 percent of District residents living with a disease that affects nearly every population group and every city neighborhood. Leading the nation in HIV rates demands that the District lead the nation in combating HIV.

But the District is not alone. Many American cities are plagued by areas of unacceptably high HIV rates, and these numbers will inevitably increase unless we change the business-as-usual mentality that has stymied the war on HIV. For more than a decade, the Centers for Disease Control and Prevention has not reported a decline in the number of new infections. Here in the District, and around the nation, the epidemic continues to rage out of control. We need a concerted, national strategy. There is no time to lose.

President Obama’s Office of National AIDS Policy is making important strides by developing the first-ever national HIV/AIDS strategy. But victory against HIV in the United States will require that this new strategy be followed with streamlined and effective implementation. Fortunately, we already have a clear model: the President’s Emergency Plan for AIDS Relief (PEPFAR), which has transformed the international fight against HIV.

Launched in 2003, PEPFAR set high expectations, and it has achieved them, bringing treatment to more than 2 million people in less than five years. When I worked on PEPFAR in Africa, I saw the program’s successes firsthand. It was more than a matter of money; PEPFAR cut through the red tape and demanded government coordination and accountability. If this can be done amid political turmoil overseas, imagine its potential here.

In the District, we have learned that if you build it, they will come. Mayor Adrian M. Fenty and D.C. Council member David A. Catania (I-At Large), chairman of the council’s Health Committee, have made HIV the District’s top public health priority. As part of that, we produced the first accurate and timely statistics on HIV/AIDS in the city — not to check a pro forma bureaucratic box but to drive the way we do business by taking an honest look at our problem. When we promoted the availability of testing and treatment, people got on board.

In two years, we doubled publicly supported HIV tests to 95,000, a number that rivals the testing in New York City and the state of Florida. We also distributed more than 3 million free condoms, and the District is one of only two cities with a free STD outreach program that reached 5,000 young people last year. We’ve helped 65 neighborhood groups learn more about HIV, worked with faith communities to raise hope and doubled the distribution of free medication. And now we are partnering with the National Institutes of Health to get even more people tested and into treatment.

But it’s not enough — because mobilizing residents to learn their HIV status results in more people requiring services. In other words, the better we do, the more we must do.

No, D.C. is not alone, but there are limits to what it or any other city can do on its own. In the United States, HIV continues to be confronted with a tangle of multiple, overlapping agencies and projects with their separate time frames, fragmented reporting and conflicting procedures. The benefits of a domestic PEPFAR are clear. Such a program would deliver not just more money for medication, care and prevention but also a single, coordinated plan of federal government supports to local jurisdictions in pursuit of specific outcomes.

In Africa and around the world, PEPFAR has saved millions of lives by providing antiretroviral treatment and coordinated prevention services where they are needed. Why should we do anything less at home?
The writer is director of the D.C. HIV/AIDS Administration.